Reframing Adolescent Development: Identifying Communications Challenges and Opportunities.

Understanding Americans' deeply held and widely shared assumptions about adolescents and their development can reveal key opportunities and challenges for developmental science communicators. Twenty-nine in-depth interviews were conducted with adolescents and adults about adolescence. We analyzed the cultural models the public use to make meaning about what adolescence is, what development involves, what adolescents need, and how adolescents can be supported. The analysis revealed several cultural models that may impede public engagement around youth issues. These dominant ways of thinking include a strong focus on the vulnerability of adolescence and a narrow understanding of how environments affect adolescent development. The findings have important implications for communicators seeking to expand and deepen public thinking about adolescence.

Route Choices and Adolescent-Adult Connections in Mitigating Exposure to Environmental Risk Factors During Daily Activities.

While adolescent-adult connections have been shown to be protective against violence perpetration and victimization, mechanisms through which these connections confer protection from violence are poorly understood. We assessed whether adolescent-adult connections protected youth in lower resource urban neighborhoods from exposure to environmental risk factors for violence during daily activities. We overlaid on the city landscape minute-by-minute activity paths from 274 randomly sampled predominantly African American male youth, ages 10 to 24, enrolled in a population-based study of daily activities in Philadelphia, PA, to calculate environmental exposures and to compare exposures along actual versus shortest potential travel routes. Adolescent-adult connections were defined using brief survey questions and detailed family genograms. Analyses demonstrated that youth's selected travel routes resulted in significantly lower exposure to several types of crime, including vandalism, narcotics arrests, and disorderly conduct, than would have occurred on shortest potential routes. On average, youth with adolescent-adult connections spent less time outdoors than youth without connections, although these differences did not reach statistical significance (p = .06). There were no significant differences in environmental risk factors encountered by youth with versus without adolescent-adult connections. Future mixed-methods research combining qualitative and geographic information systems (GIS) approaches should investigate which factors shape travel decisions during daily activities to guide multimodal violence prevention interventions.

The role of resilience in healthcare transitions among adolescent kidney transplant recipients.

PURPOSE: AYAs with KTs experience high rates of premature allograft loss during the HCT. There is a critical need to identify protective factors associated with stable HCT. Resilience-the ability to adapt and thrive in the setting of adversity-has known positive impact on health outcomes. This study explored the novel role of resilience constructs as protective factors in securing stable HCT among AYA with KT. METHODS: We conducted semi-structured interviews of adolescents and young adults who transitioned from a single pediatric transplant center to multiple adult nephrology centers between 2010 and 2017. Interviews explored the role of key resilience constructs in participants' lives around the time of HCT. Participants were stratified into stable or unstable HCT groups based on biological markers of allograft function and clinical data from chart review. Content analyses of interview transcripts were reviewed and compared among HCT groups. RESULTS: Thirty-two participants enrolled (17 stable; 15 unstable). Key resilience constructs more salient in the stable versus unstable HCT group were confidence in and connection to one's healthcare team. Reports of healthcare self-management competencies were similar across both HCT groups. CONCLUSIONS: Confidence in and connection to one's healthcare team appear to be linked with a stable HCT among AYA with KT. This suggests that interdependence, the ability to foster connections with and elicit support from healthcare providers, as opposed to complete independence or autonomy, which is often advised in the HCT process, is a critical component of resilience linked to stable HCT.

The Role of Patient and Parental Resilience in Adolescents with Chronic Musculoskeletal Pain.

OBJECTIVES: To assess the level of resilience among patients with chronic musculoskeletal pain and their parents and to determine factors associated with patient and parental resilience. STUDY DESIGN: Cross-sectional cohort study of children aged 13-17 years diagnosed with chronic musculoskeletal pain and their parents. Patient-parent pairs were seen for initial consultation in the pediatric rheumatology pain clinic at Children's Hospital of Philadelphia between March and May 2018 and were administered a series of questionnaires including measures of resilience (Connor-Davidson Resilience Scale 10 item, The 14-item Resilience Scale, and the 7Cs of Resilience Tool). We calculated Pearson correlation coefficients to examine the relationship between the variables of interest and resilience. RESULTS: According to all resilience measures, patients and parents had low to moderate levels of resilience. These levels were lower than those previously reported among healthy populations, as well as those with chronic medical conditions. According to the Connor-Davidson Resilience Scale 10 item, patient-level resilience was negatively correlated with pain level (r = -0.48), physical disability (r = -0.54), and symptom severity (r = -0.53). The level of resilience among patients was positively correlated with energy level (r = 0.57) and health-related quality of life (r = 0.64). Parental resilience was positively correlated with parental mental health (r = 0.61). CONCLUSIONS: Higher patient resilience was correlated with reduced disease severity among adolescents with chronic musculoskeletal pain. Future research should explore whether fostering resilience in adolescents with chronic musculoskeletal pain via the application of resilience-training interventions mitigates disease burden in this vulnerable patient population.

Examining the Role of Supportive Family Connection in Violence Exposure Among Male Youth in Urban Environments.

Family connection has demonstrated protective effects on violence perpetration, victimization, and witnessing in the general U.S. adolescent population. However, several studies examining the impact of family connection on violence exposure in adolescents living in low-resource urban environments have failed to demonstrate similar protective effects. We interviewed male youth in low-resource neighborhoods in Philadelphia recruited through household random sampling. Adjusted logistic regression was used to test whether a supportive relationship with an adult family member was inversely associated with violence involvement and violence witnessing. In 283 youth participants aged 10 to 24 years, 33% reported high violence involvement, 30% reported high violence witnessing, and 17% reported both. Youth who identified at least one supportive adult family member were significantly less likely to report violence involvement (odds ratio [OR] = 0.35; 95% confidence interval [CI] = [0.18, 0.69]) and violence witnessing (OR = 0.46; 95% CI = [0.24, 0.88]). Youth with two supportive parents, and those with supportive mothers only, also demonstrated significant inverse associations with violence involvement. Supportive parental relationships were inversely but not significantly related to witnessing violence. The findings suggest that supportive parental relationships may not prevent youth in low-resource neighborhoods from witnessing violence but may help prevent direct violence involvement. Next studies should be designed such that the mechanisms that confer protection can be identified, and should identify opportunities to bolster family connection that may reduce adolescent violence involvement among youth in low-resource urban environments.

Concerns and Expectations of Parents Seeking Subspecialist Care for Their Child's Short Stature.

INTRODUCTION: Parents (PP) of children in primary care clinics previously reported factors influencing their height-related medical decision making. However, patients seeking height-related care in endocrine subspecialty clinics and their parents (EP) differ demographically from the general population. OBJECTIVE: To determine EP height-related medical concerns and expectations, and to compare between EP and PP. METHODS: EP completed a survey assessing their concerns in seeking medical care for their child's height with identical questions previously asked of PP and two additional questions about growth hormone (GH) treatment. RESULTS: A greater proportion of the 166 EP (80% response rate) than the 1,820 PP (83% response rate) previously surveyed was Caucasian (75% EP, 41% PP) and privately insured (80% EP, 58% PP). Both groups rated treatment efficacy and risks most as having a bigor extreme impact on decision making (65% EP, 58% PP). The second most rated concern for EP was comparison of child's height to peers or growth chart (60% EP, 32% PP) versus child's health for PP (54% EP, 56% PP). Of the 166 EP surveyed, 76% rated GH treatment as potentially improving quality of life (QoL), with 88% reporting a minimum 3-inch height increase as necessary to improve QoL. CONCLUSIONS: Height comparisons were more likely to impact EP than PP in seeking height-related medical care for their children. EP had high expectations of QoL improvement with GH treatment, which are unlikely to be met with treatment of idiopathic short stature. Thus, clinicians should be prepared to support families in other ways that promote positive development in children with short stature.

Adult Connection in Assault Injury Prevention among Male Youth in Low-Resource Urban Environments.

Strengths-based strategies to reduce youth violence in low-resource urban communities are urgently needed. Supportive adolescent-adult relationships may confer protection, but studies have been limited by self-reported composite outcomes. We conducted a population-based case-control study among 10- to 24-year-old males in low-resource neighborhoods to examine associations between supportive adult connection and severe assault injury. Cases were victims of gunshot assault injury (n = 143) and non-gun assault injury (n = 206) from two level I trauma centers. Age- and race-matched controls (n = 283) were recruited using random digit dial from the same catchment. Adolescent-adult connections were defined by: (1) brief survey questions and (2) detailed family genograms. Analysis used conditional logistic regression. There were no significant associations between positive adult connection, as defined by brief survey questions, and either gunshot or non-gun assault injury among adolescents with high prior violence involvement (GSW OR = 2.46, 95% CI 0.81-7.49; non-gun OR = 1.59, 95% CI 0.54-4.67) or low prior violence involvement (GSW OR = 0.92, 95% CI 0.34-2.44; non-gun OR = 1.96, 95% CI 0.73-5.28). In contrast, among adolescents with high levels of prior violence involvement, reporting at least one supportive adult family member in the family genogram was associated with higher odds of gunshot assault injury (OR = 4.01, 95% CI 1.36-11.80) and non-gun assault injury (OR = 4.22, 95% CI 1.48-12.04). We were thus unable to demonstrate that positive adult connections protected adolescent males from severe assault injury in this highly under-resourced environment. However, at the time of injury, assault-injured adolescents, particularly those with high prior violence involvement, reported high levels of family support. The post-injury period may provide opportunities to intervene to enhance and leverage family connections to explore how to better safeguard adolescents.

Attitudes and Beliefs Pertaining to Sexual and Reproductive Health Among Unmarried, Female Bhutanese Refugee Youth in Philadelphia.

PURPOSE: We explored attitudes and beliefs pertaining to sexual and reproductive health (SRH) among unmarried, female, resettled Bhutanese refugees 16-20 years. METHODS: Fourteen interviews were analyzed using the constant comparison method, and major themes were identified. RESULTS: SRH was stigmatized for unmarried youth, making seeking information about SRH or accessing family planning difficult. There were many misconceptions about access to SRH. CONCLUSIONS: Universal, culturally, and linguistically appropriate comprehensive SRH education is recommended for female Bhutanese refugee youth. Terminology used should take into account differences in conceptualization of concepts like dating. Educators and health care providers should clearly describe consent and confidentiality laws regarding adolescent SRH services.

Protective Effects of Adolescent-Adult Connection on Male Youth in Urban Environments.

PURPOSE: Positive adult connection has been linked with protective effects among U.S. adolescents. Less is known about the impact of adult connection across multiple health domains for youth in low-resource urban environments. We examined the associations between adult connection and school performance, substance use, and violence exposure among youth in low-resource neighborhoods. METHODS: We recruited a population-based random sample of 283 male adolescents in Philadelphia. Age-adjusted logistic regression tested whether positive adult connection promoted school performance and protected against substance use and violence exposure. RESULTS: Youth with a positive adult connection had significantly higher odds of good school performance (odds ratio [OR], 2.8; p < .05), and lower odds of alcohol use (OR, .4; p < .05), violence involvement (OR, .3-.4; p < .05), and violence witnessing (OR, .3; p < .05). CONCLUSIONS: Promoting adult connection may help safeguard youth in urban contexts. Youth-serving professionals should consider assessing adult connection as part of a strengths-based approach to health promotion for youth in low-resource neighborhoods.

Parental Concerns Influencing Decisions to Seek Medical Care for a Child's Short Stature.

AIMS: To examine parental concerns about child growth and factors that drive parents' decisions whether to intervene medically with their child's height. METHODS: Parents of 9- to 14-year-old pediatric primary care patients of various heights, oversampled for those with short stature, participated in exploratory focus groups and nominal group technique sessions. Growth concerns expressed by the groups were incorporated into a survey, completed by 1,820 parents, and rated for their degree of impact on medical decision-making. Ordinal logistic regression modeled concern scores against parent traits. Explanatory focus groups clarified the survey results. RESULTS: Research team consensus and factor analysis organized the 22 distinct concerns expressed by the parent groups into 7 categories. Categories rated as having the greatest influence on parental decision-making involved: treatment efficacy and side effects, child health and psychosocial function. Level of concern was highly associated with parental education and parenting style. CONCLUSION: Psychosocial issues are influential, but parental decision-making is most impacted by concerns about treatment and child health. By discussing the real risks and benefits of hormone treatment and addressing parents' perceptions of what is needed for physical and psychosocial health, clinicians can be highly effective educators to assure that treatment is used only as medically indicated.

Internet informs parents about growth hormone.

BACKGROUND: Parents' knowledge influences decisions regarding medical care for their children. METHODS: Parents of pediatric primary care patients aged 9-14 years, irrespective of height, participated in open focus groups (OFGs). Moderators asked the question, 'How do people find out about growth hormone (GH)?' Because many parents cited the Internet, the top 10 results from the Google searches of 'growth hormone children' and 'parents of children who take growth hormone' were examined. Three investigators independently performed content analysis and then reached a consensus. The results were tabulated via summary statistics. RESULTS: Eighteen websites were reviewed, most with the purpose of education (56%) and many funded by commercial sources (44%). GH treatment information varied, with 33% of the sites containing content only about US FDA-approved indications. Fifty-six percent of the sites included information about psychosocial benefits from treatment, with 44% acknowledging them as controversial. Although important to OFG participants, risks and costs were each omitted from 39% of the websites. CONCLUSION: Parents often turn to the Internet for GH-related information for their children, although its content may be incomplete and/or biased. Clinicians may want to provide parents with tools for critically evaluating Internet-based information, a list of prereviewed websites, or their own educational materials.

Determining subgroups of teens for targeted driving injury prevention strategies: a latent class analysis approach.

OBJECTIVE: To utilize teen traffic safety belief profiles to improve targeting of resources and messages to young novice drivers. METHODS: The National Young Driver Survey is a nationally representative sample 5665 of 9th to 11th graders in the United States. Using latent class analysis, we grouped beliefs about 25 safety-relevant behaviors into a summary set of belief profiles and related these profiles to demographics and driver/passenger experience. RESULTS: We determined 5 safety belief profiles of teens: "everything" (rated most of the 25 behaviors as important to safety); "drivers/personal responsibility" (rated driver-related behaviors but few others as important); "driver drinking" (rated only driver alcohol use as always important); "distractions/external forces" (rated predominantly passenger rather than driver issues as important); and "nothing" (rated no issues as important). Three key groups emerged who were more likely than their counterparts to belong to the distractions/external forces than the everything class and for whom targeted messaging might be effective: males, non-white adolescents, and teens who had experienced an injury crash as a driver. CONCLUSIONS: The classes appear to organize around the locus of control (LOC) social learning framework, with some teens perceiving crashes resulting primarily from their own behavior and others believing that forces in their environment determine the events that result in a crash. Designing interventions that help young drivers understand their role in crashes may help improve the safety behavior of young drivers. In particular, for those involved in crashes, interventions designed to help them understand that the crash was a result of their actions, rather than a random or externally driven event, may influence them to take control with safety-oriented behaviors.

Racial differences in parents' perceptions of factors important for children to live well with diabetes.

PURPOSE: The purpose of this study is to learn how to serve families with children with diabetes in a more culturally effective manner by exploring and more fully understanding differences in how white and African American families ranked factors they perceived as important to living well with diabetes. METHODS: This is a secondary analysis of a survey derived from qualitative and quantitative data. A total of 799 parents (84.1% white, 12.3% African American) completed the mailed survey. Respondents were asked to rate how much of a difference each of 30 survey items makes in a child and family who are living well with diabetes, which were placed in rank order by race. Items were combined into clinically relevant categories, and mean ratings for each category were calculated. Regression analyses were used to test for racial differences between items and within categories. RESULTS: The racial groups expressed many similar views; however, 2 major themes emerged reflecting racial differences in the prioritization of factors affecting the well-being of children with diabetes. First, African American families ascribed greater importance to social supports. Second, African Americans expressed a preference for interventions that target the whole family versus the individual child, whereas whites tended to prefer child-centered interventions. CONCLUSION: There is a paucity of research on the goals and priorities of pediatric diabetes care from the perspective of parents from diverse racial backgrounds. Asking families about the type of care they prefer may help to improve the design and delivery of services in a culturally competent, effective manner.

The importance of play in promoting healthy child development and maintaining strong parent-child bond: focus on children in poverty.

Play is essential to the social, emotional, cognitive, and physical well-being of children beginning in early childhood. It is a natural tool for children to develop resiliency as they learn to cooperate, overcome challenges, and negotiate with others. Play also allows children to be creative. It provides time for parents to be fully engaged with their children, to bond with their children, and to see the world from the perspective of their child. However, children who live in poverty often face socioeconomic obstacles that impede their rights to have playtime, thus affecting their healthy social-emotional development. For children who are underresourced to reach their highest potential, it is essential that parents, educators, and pediatricians recognize the importance of lifelong benefits that children gain from play.

Resilience in action: an evidence-informed, theoretically driven approach to building strengths in an office-based setting.

Positive Youth Development and resilience-based strategies designed to develop youth capabilities are promising means to reduce risky behaviors. This article focuses on applying a strengths-based approach in a health setting. It is anchored in behavioral models that propose that people make health-promoting decisions when they possess enough information to wish to change, motivation to drive them toward change, and the skill sets to take action toward and then maintain healthier behaviors. It considers how our interactions will benefit when we (1) form a trustworthy connection and health-promoting partnership, (2) use a behavioral screen that addresses risk in the context of existing strengths, (3) elicit strengths as well as challenges, (4) facilitate youth to derive their own solutions, and (5) offer teens positive coping strategies.